Genome-wide RNAi screen identifies broadly-acting host factors that inhibit arbovirus infection

Vector-borne viruses are an important class of emerging and re-emerging pathogens; thus, an improved understanding of the cellular factors that modulate infection in their respective vertebrate and insect hosts may aid control efforts. In particular, cell-intrinsic antiviral pathways restrict vector-borne viruses including the type I interferon response in vertebrates and the RNA interference (RNAi) pathway in insects. However, it is likely that additional cell-intrinsic mechanisms exist to limit these viruses. Since insects rely on innate immune mechanisms to inhibit virus infections, we used Drosophila as a model insect to identify cellular factors that restrict West Nile virus (WNV), a flavivirus with a broad and expanding geographical host range. Our genome-wide RNAi screen identified 50 genes that inhibited WNV infection. Further screening revealed that 17 of these genes were antiviral against additional flaviviruses, and seven of these were antiviral against other vector-borne viruses, expanding our knowledge of invertebrate cell-intrinsic immunity. Investigation of two newly identified factors that restrict diverse viruses, dXPO1 and dRUVBL1, in the Tip60 complex, demonstrated they contributed to antiviral defense at the organismal level in adult flies, in mosquito cells, and in mammalian cells. These data suggest the existence of broadly acting and functionally conserved antiviral genes and pathways that restrict virus infections in evolutionarily divergent hosts.

Genome-wide RNAi screen identifies SEC61A and VCP as conserved regulators of Sindbis virus entry

Alphaviruses are a large class of insect-borne human pathogens and little is known about the host-factor requirements for infection. To identify such factors, we performed a genome-wide RNAi screen using model Drosophila cells and validated 94 genes that impacted infection of Sindbis virus (SINV), the prototypical alphavirus. We identified a conserved role for SEC61A and valosin-containing protein (VCP) in facilitating SINV entry in insects and mammals. SEC61A and VCP selectively regulate trafficking of the entry receptor NRAMP2, and loss or pharmacological inhibition of these proteins leads to altered NRAMP2 trafficking to lysosomal compartments and proteolytic digestion within lysosomes. NRAMP2 is the major iron transporter in cells, and loss of NRAMP2 attenuates intracellular iron transport. Thus, this study reveals genes and pathways involved in both infection and iron homeostasis that may serve as targets for antiviral therapeutics or for iron-imbalance disorders.

Natural resistance-associated macrophage protein is a cellular receptor for sindbis virus in both insect and mammalian hosts

Alphaviruses, including several emerging human pathogens, are a large family of mosquito-borne viruses with Sindbis virus being a prototypical member of the genus. The host factor requirements and receptors for entry of this class of viruses remain obscure. Using a Drosophila system, we identified the divalent metal ion transporter natural resistance-associated macrophage protein (NRAMP) as a host cell surface molecule required for Sindbis virus binding and entry into Drosophila cells. Consequently, flies mutant for dNRAMP were protected from virus infection. NRAMP2, the ubiquitously expressed vertebrate homolog, mediated binding and infection of Sindbis virus into mammalian cells, and murine cells deficient for NRAMP2 were nonpermissive to infection. Alphavirus glycoprotein chimeras demonstrated that the requirement for NRAMP2 is at the level of Sindbis virus entry. Given the conserved structure of alphavirus glycoproteins, and the widespread use of transporters for viral entry, other alphaviruses may use conserved multipass membrane proteins for infection.

Rift valley fever virus infection of human cells and insect hosts is promoted by protein kinase C epsilon

As an arthropod-borne human pathogen, Rift Valley fever virus (RVFV) cycles between an insect vector and mammalian hosts. Little is known about the cellular requirements for infection in either host. Here we developed a tissue culture model for RVFV infection of human and insect cells that is amenable to high-throughput screening. Using this approach we screened a library of 1280 small molecules with pharmacologically defined activities and identified 59 drugs that inhibited RVFV infection with 15 inhibiting RVFV replication in both human and insect cells. Amongst the 15 inhibitors that blocked infection in both hosts was a subset that inhibits protein kinase C. Further studies found that infection is dependent upon the novel protein kinase C isozyme epsilon (PKCε) in both human and insect cells as well as in adult flies. Altogether, these data show that inhibition of cellular factors required for early steps in the infection cycle including PKCε can block RVFV infection, and may represent a starting point for the development of anti-RVFV therapeutics.

Innate antiviral immunity in Drosophila

The study of Drosophila, and other genetically tractable insects, has expanded our understanding of innate immunity and more recently antiviral innate mechanisms. The Drosophila antiviral program includes inflammatory signaling cascades as well as antiviral RNA silencing and autophagy. This review will highlight the recent discoveries in antiviral immunity in insects and will reveal some of the lessons learned.

Novel phosphorylcholine-containing protein of Pseudomonas aeruginosa chronic infection isolates interacts with airway epithelial cells

Pseudomonas aeruginosa undergoes phase variation in the expression of the phosphorylcholine (ChoP) epitope, a structure crucial for the virulence of several respiratory pathogens. In this study, ChoP expression analysis comparing organisms from acute and chronic infections revealed that expression of ChoP at 37 degrees C was higher among strains from chronic infections. Coimmunoprecipitation experiments and mass spectrometry analysis demonstrated that ChoP was on the protein elongation factor Tu. The presence of ChoP at the surface was confirmed by immunofluorescence and flow cytometry analysis of intact bacteria. Pretreatment of bronchial epithelial cells or mice with a platelet-activating factor receptor (PAFR) antagonist reduced adhesion and invasion of the ChoP-positive P. aeruginosa isolates. Results of this study suggest that ChoP expression may represent a novel phenotype expressed by the chronic infection isolates that could mediate P. aeruginosa colonization of the epithelial airway by means of the interaction with the PAFR.

Analysis of the interaction of Ebola virus glycoprotein with DC-SIGN (dendritic cell-specific intercellular adhesion molecule 3-grabbing nonintegrin) and its homologue DC-SIGNR

BACKGROUND

The lectin DC-SIGN (dendritic cell-specific intercellular adhesion molecule 3-grabbing nonintegrin) augments Ebola virus (EBOV) infection. However, it its unclear whether DC-SIGN promotes only EBOV attachment (attachment factor function, nonessential) or actively facilitates EBOV entry (receptor function, essential).

METHODS

We investigated whether DC-SIGN on B cell lines and dendritic cells acts as an EBOV attachment factor or receptor.

RESULTS

Engineered DC-SIGN expression rendered some B cell lines susceptible to EBOV glycoprotein (EBOV GP)-driven infection, whereas others remained refractory, suggesting that cellular factors other than DC-SIGN are also required for susceptibility to EBOV infection. Augmentation of entry was independent of efficient DC-SIGN internalization and might not involve lectin-mediated endocytic uptake of virions. Therefore, DC-SIGN is unlikely to function as an EBOV receptor on B cell lines; instead, it might concentrate virions onto cells, thereby allowing entry into cell lines expressing low levels of endogenous receptor(s). Indeed, artificial concentration of virions onto cells mirrored DC-SIGN expression, confirming that optimization of viral attachment is sufficient for EBOV GP-driven entry into some B cell lines. Finally, EBOV infection of dendritic cells was only partially dependent on mannose-specific lectins, such as DC-SIGN, suggesting an important contribution of other factors.

CONCLUSIONS

Our results indicate that DC-SIGN is not an EBOV receptor but, rather, is an attachment-promoting factor that boosts entry into B cell lines susceptible to low levels of EBOV GP-mediated infection.

The C-type lectin receptors CLEC-2 and Dectin-1, but not DC-SIGN, signal via a novel YXXL-dependent signaling cascade

The two lectin receptors, CLEC-2 and Dectin-1, have been shown to signal through a Syk-dependent pathway, despite the presence of only a single YXXL in their cytosolic tails. In this study, we show that stimulation of CLEC-2 in platelets and in two mutant cell lines is dependent on the YXXL motif and on proteins that participate in signaling by immunoreceptor tyrosine-based activation motif receptors, including Src, Syk, and Tec family kinases, and on phospholipase Cgamma. Strikingly, mutation of either Src homology (SH) 2 domain of Syk blocks signaling by CLEC-2 despite the fact that it has only a single YXXL motif. Furthermore, signaling by CLEC-2 is only partially dependent on the BLNK/SLP-76 family of adapter proteins in contrast to that of immunoreceptor tyrosine-based activation motif receptors. The C-type lectin receptor, Dectin-1, which contains a YXXL motif preceded by the same four amino acids as for CLEC-2 (DEDG), signals like CLEC-2 and also requires the two SH2 domains of Syk and is only partially dependent on the BLNK/SLP-76 family of adapters. In marked contrast, the C-type lectin receptor, DC-SIGN, which has a distinct series of amino acids preceding a single YXXL, signals independent of this motif. A mutational analysis of the DEDG sequence of CLEC-2 revealed that the glycine residue directly upstream of the YXXL tyrosine is important for CLEC-2 signaling. These results demonstrate that CLEC-2 and Dectin-1 signal through a single YXXL motif that requires the tandem SH2 domains of Syk but is only partially dependent on the SLP-76/BLNK family of adapters.

The neutralizing antibody response against West Nile virus in naturally infected horses

A major neutralizing epitope (here referred to as the T332 epitope) located on the lateral surface of domain III (DIII) of the West Nile virus (WNV) envelope protein has been identified based on the analysis of murine monoclonal antibodies. However, little is known about the humoral immune response against WNV in a natural host or whether DIII in general or the T332 epitope in particular are important targets of neutralizing antibodies in vivo. To characterize the types of antibodies produced during infection with WNV, we studied a group of naturally infected horses. Using immune adsorption assays coupled with the use of virus particles bearing mutations in the T332 epitope, we found that in some animals neutralizing activity against DIII and the T332 epitope was below the limit of detection. In contrast, some animals generated a significant fraction of neutralizing activity to DIII and the T332 epitope. Thus, while antibodies to the T332 epitope did not represent a significant fraction of the total antibody response in the infected animals studied, in some horses, they comprised a significant fraction of neutralizing activity, making this an important but far from dominant neutralizing epitope. Rather, the neutralizing response to WNV generated in infected horses is both variable and polyclonal in nature, with epitopes within and outside of DIII playing important roles.

West Nile virus discriminates between DC-SIGN and DC-SIGNR for cellular attachment and infection

The C-type lectins DC-SIGN and DC-SIGNR bind mannose-rich glycans with high affinity. In vitro, cells expressing these attachment factors efficiently capture, and are infected by, a diverse array of appropriately glycosylated pathogens, including dengue virus. In this study, we investigated whether these lectins could enhance cellular infection by West Nile virus (WNV), a mosquito-borne flavivirus related to dengue virus. We discovered that DC-SIGNR promoted WNV infection much more efficiently than did DC-SIGN, particularly when the virus was grown in human cell types. The presence of a single N-linked glycosylation site on either the prM or E glycoprotein of WNV was sufficient to allow DC-SIGNR-mediated infection, demonstrating that uncleaved prM protein present on a flavivirus virion can influence viral tropism under certain circumstances. Preferential utilization of DC-SIGNR was a specific property conferred by the WNV envelope glycoproteins. Chimeras between DC-SIGN and DC-SIGNR demonstrated that the ability of DC-SIGNR to promote WNV infection maps to its carbohydrate recognition domain. WNV virions and subviral particles bound to DC-SIGNR with much greater affinity than DC-SIGN. We believe this is the first report of a pathogen interacting more efficiently with DC-SIGNR than with DC-SIGN. Our results should lead to the discovery of new mechanisms by which these well-studied lectins discriminate among ligands.

N-linked glycosylation of west nile virus envelope proteins influences particle assembly and infectivity

West Nile virus (WNV) encodes two envelope proteins, premembrane (prM) and envelope (E). While the prM protein of all WNV strains contains a single N-linked glycosylation site, not all strains contain an N-linked site in the E protein. The presence of N-linked glycosylation on flavivirus E proteins has been linked to virus production, pH sensitivity, and neuroinvasiveness. Therefore, we examined the impact of prM and E glycosylation on WNV assembly and infectivity. Similar to other flaviviruses, expression of WNV prM and E resulted in the release of subviral particles (SVPs). Removing the prM glycosylation site in a lineage I or II strain decreased SVP release, as did removal of the glycosylation site in a lineage I E protein. Addition of the E protein glycosylation site in a lineage II strain that lacked this site increased SVP production. Similar results were obtained in the context of either reporter virus particles (RVPs) or infectious lineage II WNV. RVPs or virions bearing combinations of glycosylated and nonglycosylated forms of prM and E could infect mammalian, avian, and mosquito cells (BHK-21, QT6, and C6/36, respectively). Those particles lacking glycosylation on the E protein were modestly more infectious per genome copy on BHK-21 and QT6 cells, while this absence greatly enhanced the infection of C6/36 cells. Thus, glycosylation of WNV prM and E proteins can affect the efficiency of virus release and infection in a manner that is cell type and perhaps species dependent. This suggests a multifaceted role for envelope N-linked glycosylation in WNV biology and tropism.

Characterization of neutralizing antibodies to West Nile virus

We produced nine monoclonal antibodies (MAbs) directed against the West Nile virus E glycoprotein using three different immunization strategies: inactivated virus, naked DNA, and recombinant protein. Most of the MAbs bound to conformation dependent epitopes in domain III of the E protein. Four of the MAbs neutralized WNV infection and bound to the same region of domain III with high affinity. The neutralizing MAbs were obtained from mice immunized with inactivated virus alone or in combination with a DNA plasmid. In contrast, MAbs obtained by immunization with a soluble version of the E glycoprotein did not exhibit neutralizing activity. These non-neutralizing antibodies were cross-reactive with several other flaviviruses, including Saint Louis encephalitis, Japanese encephalitis, Yellow Fever and Powassan viruses. Interestingly, some non-neutralizing MAbs bound with high affinity to domains I or III, indicating that both affinity and the precise epitope recognized by an antibody are important determinants of WNV neutralization.

An infectious West Nile Virus that expresses a GFP reporter gene

West Nile virus is a mosquito-borne, neurotropic flavivirus that causes encephalitis in humans and animals. Since being introduced into the Western hemisphere in 1999, WNV has spread rapidly across North America, identifying this virus as an important emerging pathogen. In this study, we developed a DNA-launched infectious molecular clone of WNV that encodes a GFP reporter gene. Transfection of cells with the plasmid encoding this recombinant virus (pWNII-GFP) resulted in the production of infectious WNV capable of expressing GFP at high levels shortly after infection of a variety of cell types, including primary neurons and dendritic cells. Infection of cells with WNII-GFP virus was productive, and could be inhibited with both monoclonal antibodies and interferon-beta, highlighting the potential of this system in the development and characterization of novel inhibitors and therapeutics for WNV infection. As expected, insertion of the reporter gene into the viral genome was associated with a reduced rate of viral replication, providing the selective pressure for the development of variants that no longer encoded the full-length reporter gene cassette. We anticipate this DNA-based, infectious WNV reporter virus will allow novel approaches for the study of WNV infection and its inhibition both in vitro and in vivo.

Function of herpes simplex virus type 1 gD mutants with different receptor-binding affinities in virus entry and fusion

We have studied the receptor-specific function of four linker-insertion mutants of herpes simplex virus type 1 glycoprotein D (gD) representing each of the functional regions of gD. We used biosensor analysis to measure binding of the gD mutants to the receptors HVEM (HveA) and nectin-1 (HveC). One of the mutants, gD(inverted Delta 34t), failed to bind HVEMt but showed essentially wild-type (WT) affinity for nectin-1t. The receptor-binding kinetics and affinities of the other three gD mutants varied over a 1,000-fold range, but each mutant had the same affinity for both receptors. All of the mutants were functionally impaired in virus entry and cell fusion, and the levels of activity were strikingly similar in these two assays. gD(inverted Delta 34)-containing virus was defective on HVEM-expressing cells but did enter nectin-1-expressing cells to about 60% of WT levels. This showed that the defect of this form of gD on HVEM-expressing cells was primarily one of binding and that this was separable from its later function in virus entry. gD(inverted Delta 243t) showed WT binding affinity for both receptors, but virus containing this form of gD had a markedly reduced rate of entry, suggesting that gD(inverted Delta 243) is impaired in a postbinding step in the entry process. There was no correlation between gD mutant activity in fusion or virus entry and receptor-binding affinity. We conclude that gD functions in virus entry and cell fusion regardless of its receptor-binding kinetics and that as long as binding to a functional receptor occurs, entry will progress.

Variability of critical epitopes within HIV-1 heptad repeat domains for selected entry inhibitors in HIV-infected populations worldwide [corrected]

BACKGROUND

Two of the fusion inhibitors T-20 and 5-helix polypeptide have been shown to be potent inhibitors of cell-to-cell fusion and are currently under investigation as therapy for HIV-1.

OBJECTIVES

To examine variability of HIV-1 gp41 heptads repeat regions (HR1 and HR2), with special emphasis on the presence of T-20 resistance mutations and 5-helix variability at critical epitopes, in treatment-naive patients infected with diverse HIV-1 subtypes from different geographic regions.

METHODS

A total of 150 specimens representing HIV-1 group M subtypes (A-G) from persons naive to HIV-1 viral entry inhibitor therapy were used to amplify and sequence a 506 bp segment of transmembrane protein.

RESULTS

In general, both HR1 (a.a. 540-593) and HR2 (a.a. 628-673) domains were highly conserved. Sequence analysis of the T-20 resistant domain (a.a. 547-549, GIV) revealed that 99% of the specimens (149 of 150) carried a T-20 sensitive genotype. The critical epitopes involved in the 5-helix interaction include residues at positions 628W, 631W, 635I, 638Y, 642I, 645L, 649S, 652Q, 656N, and 659E. Analysis of the 150 specimens revealed that all had identical residues at six of these positions, whereas two positions had minor variations (635 and 649) and two (645 and 659) appeared to have subtype-specific substitutions.

CONCLUSIONS

This data indicates that there is limited resistance to T-20 in these worldwide populations and that the critical epitopes for effective 5-helix binding are highly conserved across all subtypes. Taken together, these data suggest that T-20 and 5-helix should provide useful additives to current antiretroviral therapy for clinical management of HIV disease.

Epithelioid sarcoma: clinical, MR imaging and pathologic findings

OBJECTIVE

To report and describe the MR imaging features of eight new cases of this rare soft tissue sarcoma and correlate them with the clinical and histologic findings. DESIGN AND PATIENTS. Retrospective analysis was carried out for the MR imaging characteristics and histologic findings of eight patients with pathologically proven epithelioid sarcoma and the literature was reviewed. Findings were correlated in each case with the patient's clinical presentation and eventual outcome.

RESULTS

The patients, whose primary tumors ranged from 2.5 cm to 19 cm in maximum dimension, were 1 to 90 years of age. Tumors involved the extremities ( n=5), the scalp ( n=2) and the paraspinal muscles ( n=1). Five tumors presented as well-defined, frequently painful, deeply situated masses and three as subcutaneous nodules or cutaneous ulcers with no palpable mass. Four patients had associated regional lymphadenopathy and one had distant metastases at diagnosis. MR imaging showed tumor infiltration of adjacent tissues in seven patients. Signal characteristics reflected varying degrees of cellularity, and the presence of necrosis, hemorrhage, fibrosis, hyalinization and inflammation. Bone marrow involvement was demonstrated in one patient. Clinical outcomes were generally poor.

CONCLUSIONS

Epithelioid sarcoma is an aggressive soft tissue sarcoma with a varied clinical presentation, growth pattern, MR signal characteristics and histologic picture. The tumor favors the distal extremities and is commonly infiltrative and accompanied by enlarged regional lymph nodes. This neoplasm may present as an intramuscular mass but should also be suspected in patients with ulcerating cutaneous nodules with or without regional lymphadenopathy.

Predominance of HIV type 1 subtype G among commercial sex workers from Kinshasa, Democratic Republic of Congo

We have investigated the genetic diversity and potential mosaic genomes of HIV-1 during the early part of the HIV-1 epidemic among commercial sex workers (CSWs) in Kinshasa, Democratic Republic of Congo (formerly Zaire). Serologic analysis revealed that 27 (28.7%) of the 94 specimens were seropositive by both peptide and whole-virus lysate EIAs and that 24 were positive by molecular screening assays, using generic primers that can detect all known groups of HIV-1. Phylogenetic analyses of the gag(p24), C2V3, and gp41 regions of these 24 specimens showed that all were group M; none of them had any evidence of group O, N, or SIVcpz-like sequences. On the basis of env sequence analysis, the 24 group M specimens were classified as subtypes G (37.5%), A (21%), F1 (12.5%), CRF01_AE (8%), D (4%), and H (4%); 3 (12.5%) were unclassifiable (U). Similar analysis of the gag(p24) region revealed that the majority of infections were subtype A; however, one-third of the specimens were subtype G. Parallel analysis of gag(p24) and env regions revealed discordant subtypes in many specimens that may reflect possible dual and/or recombinant viruses. These data suggest a predominance of subtype G (both pure G and recombinant CRF02_AG) during the early part of the epidemic in Kinshasa. Infections with group N or SIVcpz-like viruses were not present among these CSWs in Kinshasa.

Comparison of proteins expressed by Pseudomonas aeruginosa strains representing initial and chronic isolates from a cystic fibrosis patient: an analysis by 2-D gel electrophoresis and capillary column liquid chromatography-tandem mass spectrometry

Isolates of Pseudomonas aeruginosa from chronic lung infections in cystic fibrosis (CF) patients have phenotypes distinct from those initially infecting CF patients, as well as from other clinical or environmental isolates. To gain a better understanding of the differences in these isolates, protein expression was followed using two-dimensional (2-D) gel electrophoresis and protein identification by peptide sequencing using micro-capillary column liquid chromatography-tandem mass spectrometry (microLC/MS/MS). The isolates selected for this analysis were from the sputum of a CF patient: strain 383 had a nonmucoid phenotype typical of isolates from the environment, and strain 2192, obtained from the same patient, had a mucoid phenotype typical of isolates from chronic CF lung infections. Strains 383 and 2192 were confirmed to be genetically identical by restriction endonuclease analysis, random amplified polymorphic DNA-PCR, and pulsed-field gel electrophoresis. Conditions of protein extraction were optimized for consistent high-resolution separation of several hundred proteins from these clinical isolates as detected by Coomassie staining of 2-D gels. Fourteen proteins were selected for analysis; this group included those whose expression was common between both strains as well as unique for each strain. The proteins were identified by microLC/MS/MS of the peptides produced by an in-gel tryptic digestion and compared to translated data from the Pseudomonas Genome Project; optimization of this technique has allowed for the comparison of proteins expressed by strains 383 and 2192.

Pediatric musculoskeletal lesions simulating neoplasms

Radiologists who interpret images of pediatric oncology patients may also be presented with nonneoplastic lesions that bear a clinical or radiographic resemblance to a malignant bone or soft-tissue sarcoma. In these cases, it is often desirable to avoid biopsy. Although not always specific, MR imaging can, in many instances, increase the confidence with which the radiologist is able to rule out malignancy. This article describes the common developmental, infectious, traumatic, and iatrogenic lesions in which the initial presentation is that of a malignant, musculoskeletal neoplasm.

MR imaging of malignant soft-tissue tumors

Nearly 6000 cases of soft-tissue sarcoma are diagnosed annually. Many are evaluated with MR imaging, which, because of its superior tissue contrast, has become the most important tool for detecting, staging, and monitoring treatment of the primary tumor. Although irregular margins, invasion of bone, and vascular encasement are indicators of soft-tissue malignancy, sarcomas may also be localized and well-circumscribed. Regardless of their histology, most soft-tissue sarcomas are similar in intensity to muscle on T1-weighted images and intermediate to high signal relative to fat on T2-weighted images. The addition of paramagnetic contrast agents can help differentiate between recurrent primary tumor and postoperative fluid collections.

Increased confidence of diagnosis of Ewing sarcoma using T2-weighted MR images

To assess whether magnetic resonance imaging could assist in diagnosing Ewing sarcoma, we retrospectively analyzed T1- and T2-weighted images of 24 consecutive solitary lytic bone lesions, including 18 cases of histologically proven Ewing sarcoma, and six aggressive-appearing benign lesions including eosinophilic granuloma and osteomyelitis (3 cases each). Images were obtained using a (1.0T) Siemens GBSII system. No signal intensity differences were noted among the various lesions on T1-weighted images. The observed differences in T2-weighted marrow signal intensities were scored on a 5-point scale (5 = water, 3 = fat, and 1 = muscle) and then histologically correlated. Sixteen of 18 Ewing sarcomas showed homogeneous T2-weighted signal isointense with fat and two were heterogeneous. Signals for all 6 benign lesions were homogeneous and more intense than fat on T2-weighted images. All Ewing sarcomas had associated soft tissue masses whereas, only one benign lesion, an eosinophilic granuloma had a small soft tissue component. In our patient population, a homogeneous intramedullary T2-weighted signal isointense with fat, and the presence of an associated soft tissue mass helped differentiate Ewing sarcoma from benign lytic lesions. The reproducibility of these results requires testing in larger series of patients using a variety of MR imaging equipment of differing field strengths.

MR imaging findings in recurrent primary osseous Ewing sarcoma

The objective of this study was to determine the value of magnetic resonance (MR) imaging in diagnosing local recurrence of Ewing sarcoma. We retrospectively reviewed radiographs, Tc99m-methylene diphosphonate (MDP) skeletal scintigraphy, computed tomography scans, and MR studies of 11 patients who had local recurrences of osseous Ewing sarcoma following initial responses to chemotherapy and local radiation. The MR images were compared to those of a control group of nine patients who had no evidence of relapse. T1- and T2-weighted MR images identified 9 of the 11 recurrences. Computed tomography was diagnostic in 4 of 6 cases evaluated, Tc99m-MDP bone scintigraphy in 4 of 11 cases, and plain radiographs in 2 of 10. MR findings at relapse included changes in signal intensity, increased extent of abnormal marrow signal on T1- and T2-weighted images, and identification of a new soft tissue mass. These findings suggest that MR imaging is valuable in the routine follow-up of primary osseous Ewing sarcoma.

Effect of hematopoietic growth factors on MR images of bone marrow in children undergoing chemotherapy

PURPOSE

To evaluate the effects of hematopoietic growth factors on magnetic resonance (MR) image signal intensity (SI) of bone marrow in children undergoing neoadjuvant chemotherapy for musculoskeletal malignancies.

MATERIALS AND METHODS

Blinded evaluations were performed of T1-weighted and short inversion time inversion recovery images of the pelvis and/or lower extremities of 15 patients undergoing chemotherapy, with or without granulocyte or granulocyte-macrophage colony-stimulating factor.

RESULTS

Four of the 11 patients who received growth factors initially had hematopoietic marrow SI that did not change during therapy. All seven with initially fatty marrow had SI changes consistent with reconversion to hematopoietic marrow that coincided temporally with increases in absolute neutrophil counts from minimums of 0-2,580/mm3 to maximums of 10,858-45,880/mm3. The four patients who did not receive growth factors had no MR imaging changes in initially hematopoietic (n = 1) or fatty (n = 3) marrow.

CONCLUSION

Hematopoietic activity induced by growth factors can produce changes in bone marrow SI that may simulate bone marrow involvement by musculoskeletal tumors.

Automated pixel-by-pixel mapping of dynamic contrast-enhanced MR images for evaluation of osteosarcoma response to chemotherapy: preliminary results

An automated technique for pixel-by-pixel computer mapping of tumor necrosis was developed to improve the accuracy and applicability of dynamic contrast agent-enhanced magnetic resonance (MR) imaging in assessing the response of osteosarcoma to preoperative chemotherapy. The technique was evaluated in nine osteosarcoma patients who underwent MR imaging at diagnosis (n = 7) and after preoperative chemotherapy (n = 9). Sequential FLASH (fast low-angle shot) images of the tumor were obtained in one plane every 15 seconds before and for 3 minutes after gadopentetate dimeglumine injection. A region of interest was selected that included the entire tumor area. Slopes representing percent increase in signal intensity over baseline values per minute were calculated automatically for each pixel and displayed as gray-scale maps of the tumor. Matching histologic maps of each tumor were obtained. Visual region-by-region comparison of the pixel and histologic maps showed a high degree of correlation and the ability of the MR imaging technique to help identify small foci of residual viable tumor.

MR imaging of infradiaphragmatic lymphadenopathy in children and adolescents with Hodgkin disease: comparison with lymphography and CT

The ability of short-inversion-time inversion recovery (STIR) magnetic resonance imaging to depict infradiaphragmatic lymphadenopathy was evaluated in 25 consecutive patients with newly diagnosed Hodgkin disease. All patients underwent computed tomography (CT) and multiplanar STIR imaging prior to lymphography (LAG). The STIR and CT images were evaluated for paraaortic and parailiac node enlargement. Findings were compared with LAG findings, which showed the architectural pattern of the opacified lymph nodes. In the upper paraaortic region, STIR imaging showed more abnormal nodes than did CT or LAG. In the lower paraaortic and parailiac regions, lymph node enlargement was shown equally well with STIR and LAG, whereas CT showed fewer enlarged lymph nodes. LAG showed paraaortic or parailiac focal tumor infiltration in three patients with normal-size nodes, and hyperplasia in two patients with enlarged nodes. STIR imaging showed more abnormal infradiaphragmatic nodes than did CT because of improved lymph node conspicuity. STIR imaging may be a useful addition to CT for staging pediatric Hodgkin disease.

Primary malignant rhabdoid tumor of the brain: clinical, imaging, and pathologic findings

PURPOSE

To describe the imaging and pathologic findings of malignant rhabdoid tumor (MRT), a rare primary brain neoplasm affecting children.

METHODS

The CT and/or MR features, pathologic findings, and clinical records of three children with primary MRT of the brain were retrospectively reviewed.

RESULTS

The tumors, large, left-sided cerebral masses, were intraventricular in two cases. MR images in one patient showed T1- and T2-weighted signal intensity isointense with gray matter. Multiple necrotic/cystic foci were present in all cases, with two showing a patchy pattern of enhancement on CT and MR. The diagnosis of MRT was documented by ultrastructural and immunohistochemical studies. All patients had normal abdominal CT scans, excluding the possibility of primary renal rhabdoid tumor metastatic to the brain. The disease progressed rapidly in each case, despite surgery, chemotherapy, and craniospinal irradiation, with serial imaging evidence of tumor regrowth at the primary site and the development of metastatic satellite lesions.

CONCLUSIONS

The diagnosis of primary MRT of the brain can be made only pathologically; however, the nonspecific imaging findings in these cases suggest that MRT should be considered in the differential diagnosis of large childhood intracranial neoplasms.

Pediatric musculoskeletal tumors: use of dynamic, contrast-enhanced MR imaging to monitor response to chemotherapy

The ability of dynamic, gadolinium-enhanced magnetic resonance (MR) imaging to allow prediction of histologic responses to initial chemotherapy was evaluated in 20 patients with osteosarcoma (n = 12), Ewing sarcoma (n = 4), rhabdomyosarcoma (n = 3), or synovial sarcoma (n = 1). Tumor signal intensity was measured on fast low-angle shot (FLASH) gradient-echo images obtained at 15-second intervals before and 3 or more minutes after manual intravenous injection of gadopentetate dimeglumine. Signal intensity was plotted against time, and slopes were calculated for the percentage increase in signal intensity per minute. Slopes and changes in maximum tumor size during and after chemotherapy were correlated with histologic evaluations of tumor response. Eleven of the 20 tumors met histologic criteria for response. Histologic response was moderately correlated with slopes obtained during chemotherapy (rs [Spearman rank correlation] = .53, P = .02) but not with changes in tumor size (rs = .02, P = .94). Tumor slopes obtained after chemotherapy were highly correlated with histologic findings (rs = .65, P = .007); the correlation with changes in tumor size increased but remained nonsignificant (rs = .41, P = .11).

Assessment of osteosarcoma response to preoperative chemotherapy using dynamic FLASH gadolinium-DTPA-enhanced magnetic resonance mapping

RATIONALE AND OBJECTIVES

To improve the accuracy of magnetic resonance imaging (MRI) in evaluating the response of osteosarcomas to preoperative chemotherapy, the authors developed a technique of mapping tumor necrosis and viability by quantitating slope values of gadolinium-DTPA (Gd-DTPA) uptake on dynamic fast low-angle shot (FLASH) images.

METHODS

Dynamic contrast-enhanced FLASH imaging of a single representative plane was performed on six osteosarcomas. Tumors were mapped by dividing resultant images into contiguous regions of interest and deriving slopes representing percentage increase in signal intensity (SI) per minute over the baseline for each region. The results were compared with estimations of viable tumor volume on subtracted Gd-DTPA-enhanced T1-weighted images and histologic maps of necrotic and viable tumor.

RESULTS

Dynamic FLASH estimations of percent tumor necrosis using a critical slope value of 45% per minute correctly predicted histologic response to chemotherapy in all six patients. Comparison of dynamic FLASH and histologic maps showed a high degree of correlation. Static enhanced T1-weighted images overestimated the amount of residual viable tumor.

CONCLUSIONS

Dynamic FLASH Gd-DTPA-enhanced mapping is a potentially useful noninvasive method of quantitating tumor response to chemotherapy.

MR imaging detection of calcified intracranial lesions and differentiation from iron-laden lesions

Magnetic susceptibility variation caused by calcium permits limited detection of intracranial calcifications and/or their distinction from iron-laden lesions with spin-echo or gradient-echo magnetic resonance (MR) techniques. The magnetic susceptibility sensitivity of phase imaging has been used to detect iron-laden lesions. A new approach that combines the magnetic susceptibility sensitivity of both gradient-echo and phase imaging to yield greater imaging sensitivity to calcium is presented. Two-dimensional fast low-angle shot (FLASH) gradient-echo imaging with phase image reconstruction (gradient-echo phase [GEP]) was used at 1.0 and 1.5 T. Twelve patients with computed tomography-proved calcified intracranial lesions (greater than or equal to 200 HU) and seven patients with iron-laden intracranial lesions having a characteristic appearance on T1- and T2-weighted and FLASH MR images were studied. The GEP imaging technique helped detect calcified intracranial lesions (greater than or equal to 200 HU) and helped distinguish them from iron-laden lesions.

Muscle edema in musculoskeletal tumors: MR imaging characteristics and clinical significance

To determine the frequency and clinical significance of tumor-associated muscle edema, magnetic resonance (MR) imaging findings in 46 consecutive patients with benign or malignant musculoskeletal lesions were reviewed. Increased muscle signal intensity on T2-weighted, STIR (short-inversion-time inversion-recovery), and gadopentetate dimeglumine-enhanced T1-weighted images was present in 41 cases, with the clearest delineation of tumor margins seen on T2-weighted images. Typical peri/paratumoral edema (PTE) was present in equal proportions of malignant (25 of 37) and benign lesions (six of nine). Massive edema involving the entirety of at least one contiguous muscle--to the authors' knowledge, a previously undescribed finding--was identified on MR images of eight malignant and two benign lesions (22% of both groups). All cases of massive edema had a substantial soft-tissue component and involved muscles disrupted by tumor at the point of attachment to bone. Malignant tumors associated with massive edema were larger than those with typical or no PTE, showed a poorer response to initial chemotherapy, and had a higher frequency of metastases at diagnosis. Thus, the presence of massive muscle edema appears to be an ominous clinical finding in patients with malignant musculoskeletal lesions.

Magnetic resonance imaging of disseminated bone marrow disease in patients treated for malignancy

Magnetic resonance imaging (MRI) is a sensitive method for the diagnosis of bone marrow abnormalities, but its usefulness in detecting active disseminated cancer in this tissue in treated patients has not been determined. We therefore examined 14 children who had been treated for disseminated bone marrow involvement by neuroblastoma (n = 6), lymphoma (n = 3), Ewing's sarcoma (n = 3), osteosarcoma (n = 1), and leukemia (n = 1). MRI studies were performed at 21 marrow sites to evaluate residual or recurrent tumor and were correlated with histologic material from the same site. T1- and T2-weighted sequences were employed in 21 and 14 studies, respectively; short tau inversion recovery (STIR) in 18; and static gadolinium diethylene triamine pentaacetic acid (Gd-DPTA)-enhanced. T1-weighted sequences in 13. All MRI studies showed an altered bone marrow signal. Technetium 99m methylene diphosphonate (99mTc-MDP) bone scintigraphy was also performed (19 studies). On histologic examination, 7 marrow specimens contained tumor, and 14 did not. Of the 7 tumor-positive lesions, all T1-weighted, 4 of 6 T2-weighted, and all 6 STIR sequences showed abnormal signal; all 5 Gd-DTPA-enhanced. T1-weighted sequences showed enhancement of the lesion. However, abnormal signals were also observed on all T1-weighted, 6 of 8 T2-weighted, 11 of 12 STIR, and 5 of 8 Gd-DTPA-enhanced, T1-weighted images of the tumor-negative sites. In this clinical setting, MRI did not consistently differentiate changes associated with treatment from malignant disease.

Value of subtraction images in the detection of hemorrhagic brain lesions on contrast-enhanced MR images

Contrast-enhanced T1-weighted MR images are known to improve the detection and conspicuity of CNS lesions; however, lesion enhancement may be indistinguishable from contiguous hemorrhagic areas of intrinsically increased signal intensity. In a series of cranial MR studies in 22 pediatric oncologic patients with evidence of subacute hemorrhage, we found that subtracting the unenhanced from the enhanced T1-weighted images was essential in 14 of the cases to visualize and/or characterize the enhanced tissue in the presence of adjacent hemorrhage. In six patients, a nodular pattern of enhancement suggestive of tumor was detected and/or outlined only after subtraction. In eight patients, linear benign-appearing enhancing margins were seen clearly only after subtraction. In the remaining eight patients, the presence and shape of enhancement was verified with subtraction. Subtraction is a useful, simple, and rapid postprocessing procedure that does not increase scan time or require modification of standard pulse sequences. Subtraction separates the enhanced areas from adjacent bright hemorrhage.

Treatment of choroidal melanoma: MR imaging in the assessment of radioactive plaque position

Verification of the position of an episcleral iodine-125 gold plaque in relation to underlying choroidal melanoma is essential during early radiation therapy to ensure accurate plaque placement and thus optimum dose delivery. The authors used magnetic resonance (MR) imaging to examine 15 patients with choroidal melanoma after plaque placement to assess tumor coverage. The relationship of the plaque to the tumor was well defined in all cases, including two tumors anterior to the ora serrata. MR imaging measurements of the plaques were within 1 mm of the actual plaque sizes, while tumor measurements were within 2 mm of the preoperative ultrasound estimations of tumor dimensions. Tumors as small as 3 mm thick were readily visualized with MR imaging. Associated subretinal effusion was demonstrated in seven cases.

Changes in MR signal intensity and contrast enhancement of therapeutically irradiated soft tissue

Increased MR signal intensity was observed on T2-weighted, STIR, and Gadolinium-DTPA-enhanced T1-weighted images of subcutaneous and muscular soft tissue in 9 of 10 children treated with combination chemotherapy and radiation therapy (RT) for malignancy in the pelvis or an extremity. Total radiation doses ranged from 59.5 to 65 Gy. Eight of the patients with these changes received hyperfractionated RT (seven for Ewing sarcoma and one for perineal rhabdomyosarcoma); one was treated for pelvic hemangiopericytoma with once-daily fractions. Evidence of soft tissue damage became apparent as early as the sixth week of RT and was seen for up to 69 wk post-RT. There was no clear MR evidence of RT-induced soft tissue damage in one patient, who underwent hyperfractionated RT for pelvic rhabdomyosarcoma. Other MR findings in this group included evidence of bladder wall thickening in three of the seven patients given pelvic RT and increased T1-weighted signal of irradiated marrow in nine patients. All patients had clinical evidence of skin, soft tissue, or epithelial radiation effects. Increased MR signal intensity secondary to RT-induced damage can be differentiated from widespread tumor by geometric borders that conform to the margins of the radiation field.

Childhood chondrosarcoma: MR imaging with gadolinium-DTPA

The radiologic, CT, MR, and histological features of a case of chondrosarcoma of the femur presenting in childhood are reported. This case emphasizes the use of correlative imaging in establishing the diagnosis as well as the value of MR supplemented by Gadolinium-DTPA enhancement in disclosing abundant necrosis within the tumor.

Subtraction technique for contrast-enhanced MR images of musculoskeletal tumors

Vascularized malignant tissue, fat and hemorrhage may have similar intensities on Gd-DTPA-enhanced, T1-weighted MRI performed to evaluate musculoskeletal tumors. We describe a simple, rapid post-processing subtraction technique which resulted in improved definition of these tissues in 33 of 42 examinations. While the subtraction process is susceptible to complex patient motion, the improved contrast can be obtained without modifying standard pulse sequences.